Archive for: October, 2009

Donors choose---this is it, folks

Oct 30 2009 Published by under Donors Choose

This is the penultimate day of our Donors Choose challenge to fund needy Michigan classrooms. We have fully funded 13 separate projects and scooped up matching funds from the Gates Foundation and Hewlett-Packard.
You have all been terribly generous, but I have to ask one final favor. A generous reader just gave $100 to a project to create an outdoor science classroom focusing on gardening. It's a terrific project and that single donation has brought the project within $300 of being fully funded. If you, dear readers, could kick in even a few small donations (in the 1-5 dollar range) I think I could find a way to get this project funded before the end of the drive.
This is the last you'll hear from me until next October. If you could kick in a buck or two and get the word out on twitter, it would be very exciting.

4 responses so far


Oct 30 2009 Published by under Medicine

My swine flu shot

Getting my swine flu shot

29 responses so far

The anti-vaccination movement is morally bankrupt

Oct 28 2009 Published by under Absurd medical claims, Medicine, Vaccination inanity

A hat-tip to my buddy Abel over at TerraSig for keeping this story alive and inspiring me to chime in.  --PalMD

It's no secret that I find the anti-vaccination crowd to be abhorrent. The public's health is the first victim, followed closely by individual patients and parents struggling with individual health decisions. I cannot fault patients for making bad decisions---the anti-vaccination movement has a very effective propaganda arm. Folks like Jenny McCarthy have a large audience and make no secret of their desire to see infectious diseases increase in others:

I do believe sadly it's going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it's their f___ing fault that the diseases are coming back. They're making a product that's s___. If you give us a safe vaccine, we'll use it. It shouldn't be polio versus autism.

These folks are so focused on their own quasi-religious delusions that they can no longer properly evaluate reality.  That would be fine if they lived in isolated caves away from electronic media.  But they don't.

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61 responses so far


Oct 27 2009 Published by under Medical Musings, Medicine

The young resident presented the patient in the usual dry terms we use for such things.
"The patient is a 42 year old woman recently hospitalized for cirrhosis due to alcohol use. Her cirrhosis has been complicated by esophageal varices, encephalopathy, and refractory ascites."
In other words, the woman has drunk herself nearly to death.
"Is she still drinking?" I asked.
"She says not. She says she stopped about six months ago when she first got sick."
"What did GI say? Did they refer her for transplant evaluation?"
"No," she said, a bit disappointedly, "they said she wasn't a candidate."

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10 responses so far

Donors choose---almost there!

Oct 27 2009 Published by under Donors Choose

You guys are great. Large donations continue to trickle in, but really, we can live quite well off of small donations. It would be really cool if we finished off the drive with a bunch of micro-donations, in the 1-10 dollar range. These small donations add up really quickly.
A Story to Tell is $97 away from being fully funded, allowing the teacher to buy a laptop and printer.
Inner City Soccer Team is a bit more of a challenge with $376 to go. There is no reason we can't get this done before the end of the week.
So let's do it---a buck here, a buck there, and soon enough...

One response so far

Are you a 99214 with 250.02, 401.1, and 272.2?

Oct 26 2009 Published by under Health care reform, Medicine

When I see a patient at the office, I spend time developing trust, forming a therapeutic alliance, thinking through their physical complaints, examining them, and applying the best evidence to formulating a plan for maintaining their health. It's a lot of fun.
Less fun is the part where I try to get paid. To bill an insurance company, I must use numeric diagnostic codes that best fit what I'm seeing, and I must pick a code representing a level of service, that is, how hard I worked.
The diagnostic codes are referred to as ICD-9 codes, and the service codes are called E/M codes. Not all ICD-9 codes are easily billable. For example, if a patient comes to see me for anxiety or depression, I can't bill for it. I can bill for "malaise and fatigue" (780.7), but not for generalized anxiety disorder (300.02) (supposedly it's possible, but, like the Loch Ness monster, it's always a friend of a friend of a friend who saw it).

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25 responses so far

Donors Choose---final days

Oct 26 2009 Published by under Donors Choose

We have some very generous readers. We've managed to fully fund 12 out of 14 proposals from needy Michigan classrooms. We can probably pull off funding the final two projects this week, and although our readers have been quite generous in the size of individual gifts, I'd love to see a bunch of micro-gifts, in the 1-10 dollar range.
Remaining Projects

  1. A Story to Tell: The teacher is trying to get a lap top and printer for her kids. That's it. She's $148 $123 away from getting it.
  2. Inner City Soccer Team: Aside from the benefit of athletics, these kids are isolated in an economically and ethnically homogenous community and the teacher wants them to be exposed to a bit more of the world. $450 left to go.

There are other projects as well, but these are the final two of the 14 original Michigan classroom projects. We have a few days. Let's get some micro-moolah flowing.

No responses yet

All I want for Christmas...

Oct 25 2009 Published by under Fatherhood

My daughter handed my wife a hand-written Channukah wish-list which I will reproduce for you in its entirety:

  1. Barbie remote corvette
  2. Barbie camper
  3. Ken doll
  4. For real elephant

I'm not sure which one we will get her, but I have my biases.

23 responses so far

Flu season---getting in to see the doctor

Oct 25 2009 Published by under Medicine

I try not to overbook at my office. I have about 16 slots every morning for returning patients (fewer if I have new patients booked, which I usually do). I usually schedule, counting new and old patients, 12 patients every morning. If I were to cut my appointment slots down to 10 minutes instead of 15, I could really pack 'em in, and I may have to do that some day, but with the 15 minute slots, I can usually squeeze in people who want to walk in because they're sick. There's only so much that can be done to control the flow; if someone has chest pain, I'm going to be running late from then on. If everyone is well, I'll be right on time.
Influenza is the destroyer of schedules. If I have 12 slots booked, and just two people with the flu want to be seen, I'm either going to squeeze them into the middle of the schedule or tack them onto the end. Either way, I'm going to run late, and patients will feel it.

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13 responses so far

Good news/Bad news: long lines for swine flu shots

Oct 25 2009 Published by under Medicine

My county health department released 10K doses of H1N1 vaccine yesterday and opened up two distribution centers for them. With all the anti-vaccination craziness out there, I was worried no one would show.
Turns out, no need to worry.
My friend went yesterday and waited for four hours with thousands of other people. From a public health perspective, perhaps it would have been better to have multiple smaller centers to avoid exposure, but people did not wait inside in crowded rooms, but outside in the wind. That's probably better, but who knows. At a time when mass vaccination is needed, and the public health infrastructure of this country is a chaotic hodge-podge of local, state, and federal institutions, it's amazing anyone gets a vaccine on time at all.
I'm happy the first round of vaccination was popular, not so happy that we had to crowd thousands of people together during a pandemic to do it. Still, it's a net good---people crowd anyway, and if they do it for vaccination, great.
So the anti-vaxers may be loud, but the public doesn't seem to be lapping it up. If we are very, very lucky, we may be able to blunt this pandemic a bit.

5 responses so far

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